Pregnancy puts women at higher risk of severe medical complications or death from COVID-19, according to a new study of more than 1,300 women in sub-Saharan Africa. Researchers argue that vaccinating pregnant women against the coronavirus should be made a priority across the region, where most countries do not yet recommend vaccination during pregnancy.

Multiple studies have already shown that COVID-19 is more dangerous to pregnant women than to those who are not pregnant. But most of the women in these studies lived in Europe, North America or Asia. Until now, little data was available from Africa.

“Africa is not Europe, is not the U.S.A.,” said Jean Nachega, an infectious disease epidemiologist at the University of Pittsburgh School of Public Health and lead author of the new study. “We should not just rely on data coming from the U.S., Europe or China to try to understand COVID on the continent.”

Populations in Africa are typically younger than those in Europe, North America and East Asia. But certain infectious diseases like HIV, malaria and tuberculosis (TB), as well as noninfectious diseases such as sickle cell anemia, are more common there. Those conditions can make it harder for the body to fight off infections.

In the study, published in the journal Clinical Infectious Diseases, Nachega and his colleagues from the AFREhealth research network analyzed health records from 1,315 women treated at hospitals in six countries in sub-Saharan Africa between March 2020 and March 2021. Roughly a third were pregnant and had tested positive for the coronavirus. Another third were pregnant and had tested negative, and the other third were not pregnant and had tested positive. The researchers tested how pregnancy, infection with the coronavirus, and conditions such as HIV, TB, malaria and sickle cell anemia affected a woman’s likelihood of severe disease or death.

The findings were grim. Pregnant women who were hospitalized in sub-Saharan Africa were five times more likely to die in the hospital if they tested positive for the coronavirus. And being pregnant doubled the odds that a woman admitted to a hospital with COVID-19 would die. 

“We had it in both ways: pregnancy impacted COVID, and COVID impacted pregnant women,” said Nachega.

Pregnant women with COVID-19 were also at higher risk of serious complications requiring intensive care. It wasn’t possible to tell whether pregnancy made the combination of COVID-19 and TB or HIV riskier, but women with HIV, TB, malaria or sickle cell who had the coronavirus were more likely to get seriously ill. 

“It’s very good that the study was conducted in sub-Saharan Africa, and it is very reassuring that the findings are consistent with the results of other studies,” said Ana Langer, a physician specializing in reproductive health and head of the Women and Health initiative at Harvard University. 

Because the study considered only hospitalized women, it wasn’t possible to tell if pregnancy makes women more likely to get infected with the coronavirus or if they get sick from it in the first place. Using data collected in the past can also cause problems with the analysis, which the researchers used statistical tools to correct. But “this was the best study they could do with the availability of funding and the other circumstances,” Langer said. 

Nachega hopes that his findings will convince policymakers in sub-Saharan Africa to recommend vaccination for pregnant women and women who could become pregnant.

“The bottom line is that pregnant women need to get vaccinated,” he said. “If not then, before even she gets pregnant. The most important implication of this study is to advocate for COVID vaccination in women of childbearing age.”

Multiple studies have shown that the COVID-19 vaccines are safe and effective during pregnancy, and 110 countriesrecommend COVID-19 vaccination for some or all pregnant women. However, only 13 of sub-Saharan Africa’s 48 countries currently do so. Lack of government support stymies efforts to make the vaccine more accessible to pregnant women and is complicated by high rates of vaccine hesitancy in sub-Saharan Africa, where only about 19% of women intend to get the vaccine.

“Women and their families are worried about their safety, they think that the vaccine could harm them, or their fetuses and babies, and it has been extensively demonstrated that that’s not the case,” said Langer. “The vaccine is safe for pregnant and breastfeeding women.”

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